Anti-vascular endothelial growth factor therapy for age-related macular degeneration: a systematic review and network meta-analysis

BACKGROUND

The comparative safety and efficacy between anti-vascular endothelial growth factor agents (anti-VEGFs) and between combined therapies for patients with neovascular age-related macular degeneration (nAMD) is unclear. We conducted a systematic review to examine the comparative safety and efficacy anti-VEGFs for adults with nAMD.

METHODS

Studies were identified through MEDLINE, EMBASE, and Cochrane CENTRAL (inception to June 3, 2019), grey literature, and scanning reference lists. Two reviewers independently screened citations and full-text articles to identify randomized controlled trials (RCTs), extracted data, and appraised risk of bias. Pairwise random-effects meta-analysis and Bayesian network meta-analysis (NMA) were conducted. The primary outcomes were the proportion of patients experiencing moderate vision gain (≥ 15 letters on the Early Treatment Diabetic Retinopathy Study chart) and the proportion of patients experiencing moderate vision loss (≤ 15 letters).

RESULTS

After screening 3647 citations and 485 potentially relevant full-text articles, 92 RCTs with 24,717 patients were included. NMA (34 RCTs, 8809 patients, 12 treatments) showed small differences among anti-VEGFs in improving the proportion of patients with moderate vision gain, with the largest for conbercept versus broluczumab (OR 0.15, 95% CrI: 0.05-0.56), conbercept versus ranibizumab (OR 0.17, 95% CrI: 0.05-0.59), conbercept versus aflibercept (OR 0.19, 95% CrI: 0.06-0.65), and conbercept versus bevacizumab (OR 0.2, 95% CrI: 0.06-0.69). In NMA (36 RCTs, 9081 patients, 13 treatments) for the proportion of patients with moderate vision loss, small differences were observed among anti-VEGFs, with the largest being for conbercept versus aflibercept (OR 0.24, 95% CrI: 0-4.29), conbercept versus brolucizumab (OR 0.24, 95% CrI: 0-4.71), conbercept versus bevacizumab (OR 0.26, 95% CrI: 0-4.65), and conbercept versus ranibizumab (OR 0.27, 95% CrI: 0-4.67).

CONCLUSION

The only observed differences were that ranibizumab, bevacizumab, aflibercept, and brolucizumab were statistically superior to conbercept in terms of the proportion of patients with nAMD who experienced moderate vision gain. However, this finding is based on indirect evidence through one small trial comparing conbercept with placebo. This does not account for drug-specific differences when assessing anatomic and functional treatment efficacy in variable dosing regimens.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42015022041.

Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

BACKGROUND

First responders are a high-risk population for occupational stress injuries as they often encounter prolonged stress within their line of work. The aim of this rapid overview of reviews is to summarize existing evidence on interventions for the prevention and management of occupational stress injury (OSI) in first responders.

METHODS

MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Library were searched for systematic reviews examining the impact of prevention, rehabilitation, and resilience-building strategies targeting frontline community safety personnel in February 2019. Pairs of reviewers screened titles and abstracts followed by full-text articles and conducted data abstraction and quality appraisal using the AMSTAR II tool. To ensure a rapid overview process, the search strategy was limited to the last 10 years, quality appraisal of reviews and abstraction of study-level data was completed by one person and verified by another, and the quality of the individual primary studies was not appraised. The findings were summarized descriptively.

RESULTS

A total of 14 reviews with 47 unique primary studies were found after screening 1393 records. A majority of studies targeted OSI in police officers (78.7%), followed by firefighters (17%) and correctional officers (4.3%). Of the 47 included primary studies, 24 targeted prevention of OSI (i.e., resilience training, stress management, suicide prevention, and other health promotions) and 23 targeted rehabilitation (i.e., drug therapy, psychotherapy, and other therapies). Prevention strategies including resilience training programs had positive outcomes, while suicide prevention and psychotherapy interventions reported mixed results.

CONCLUSIONS

Some promising interventions targeting the prevention and rehabilitation of OSI among police officers, firefighters, and correctional officers were identified in the included studies, and these results will serve as a basis for the development of evidence-based strategies to mitigate future risks in this population. However, several gaps were also identified in this area that will require further investigation prior to widespread implementation of effective interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019125945.

Exploring the prevalence of gaming disorder and Internet gaming disorder: a rapid scoping review

BACKGROUND

Internet gaming disorder (IGD) was included in the DSM-5 in 2013 as a condition requiring further research, and gaming disorder (GD) was included in the ICD-11 in 2018. Given the importance of including these conditions in diagnostic guidelines, a review was conducted to describe their prevalence.

METHODS

Using guidance from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a rapid scoping review. MEDLINE, Embase, PsycINFO, and the Cochrane library were searched for literature published from inception to July 2018. All review stages were pilot-tested to calibrate reviewers. The titles/abstracts and full-text articles were screened by one reviewer to include quantitative primary studies that reported GD or IGD prevalence. Excluded citations were screened by a second reviewer to confirm exclusion. Charting was conducted by one reviewer and verified by another, to capture relevant data. Results were summarized descriptively in tables or text.

RESULTS

We assessed 5550 potentially relevant citations. No studies on GD were identified. We found 160 studies of various designs that used 35 different methods to diagnose IGD. The prevalence of IGD ranged from 0.21-57.50% in general populations, 3.20-91.00% in clinical populations, and 50.42-79.25% in populations undergoing intervention (severe cases). Most studies were conducted in the Republic of Korea (n = 45), China (n = 29), and the USA (n = 20). Results are also presented for severe IGD and by geographic region, gender/sex, and age groups (child, adolescent, adult). The five most frequently reported health-related variables were depression (67 times), Internet addiction (54 times), anxiety (48 times), impulsiveness (37 times), and attention-deficit hyperactivity disorder (24 times).

CONCLUSIONS

Due to the variability in diagnostic approaches, knowledge users should interpret the wide IGD prevalence ranges with caution. In addition to further research on GD, consensus on the definition of IGD and how it is measured is needed, to better understand the prevalence of these conditions.

Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis

OBJECTIVES

To evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV).

DESIGN

Systematic review and random-effects meta-analysis.

METHODS

Multiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias.

RESULTS

19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6-9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients.

CONCLUSIONS

Intravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen.

PROSPERO REGISTRATION NUMBER

CRD42015022041.

Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis

OBJECTIVE

To compare the efficacy, effectiveness, and safety of the herpes zoster live attenuated vaccine with the herpes zoster adjuvant recombinant subunit vaccine or placebo for adults aged 50 and older.

DESIGN

Systematic review with bayesian meta-analysis and network meta-analysis.

DATA SOURCES

Medline, Embase, and Cochrane Library (inception to January 2017), grey literature, and reference lists of included studies.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Experimental, quasi-experimental, and observational studies that compared the live attenuated vaccine with the adjuvant recombinant subunit vaccine, placebo, or no vaccine in adults aged 50 and older. Relevant outcomes were incidence of herpes zoster (primary outcome), herpes zoster ophthalmicus, post-herpetic neuralgia, quality of life, adverse events, and death.

RESULTS

27 studies (22 randomised controlled trials) including 2 044 504 patients, along with 18 companion reports, were included after screening 2037 titles and abstracts, followed by 175 full text articles. Network meta-analysis of five randomised controlled trials found no statistically significant differences between the live attenuated vaccine and placebo for incidence of laboratory confirmed herpes zoster. The adjuvant recombinant subunit vaccine, however, was statistically superior to both the live attenuated vaccine (vaccine efficacy 85%, 95% credible interval 31% to 98%) and placebo (94%, 79% to 98%). Network meta-analysis of 11 randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more adverse events at injection sites than the live attenuated vaccine (relative risk 1.79, 95% credible interval 1.05 to 2.34; risk difference 30%, 95% credible interval 2% to 51%) and placebo (5.63, 3.57 to 7.29 and 53%, 30% to 73%, respectively). Network meta-analysis of nine randomised controlled trials showed the adjuvant recombinant subunit vaccine to be associated with statistically more systemic adverse events than placebo (2.28, 1.45 to 3.65 and 20%, 6% to 40%, respectively).

CONCLUSIONS

Using the adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using the live attenuated vaccine, but the adjuvant recombinant subunit vaccine also carries a greater risk of adverse events at injection sites.

PROTOCOL REGISTRATION

Prospero CRD42017056389.

Faraday-Talbot effect: Alternating phase and circular arrays

A hydrodynamic analog to the optical Talbot effect may be realized on the surface of a vertically shaken fluid bath when a periodic array of pillars protrudes from the fluid surface. When the pillar spacing is twice or one and a half times the Faraday wavelength, we observe repeated images of the pillars projected in front of the array. Sloshing inter-pillar ridges act as sources of Faraday waves, giving rise to self-images. Here, we explore the emergence of Faraday-Talbot patterns when the sloshing ridges between pillars have alternating phases. We present a simple model of linear wave superposition and use it to calculate the expected self-image locations, comparing them to experimental observations. We explore how alternating phase sources affect the Faraday-Talbot patterns for linear and circular arrays of pillars, where curvature allows for magnification and demagnification of the self-imaging pattern. The use of an underlying wavefield is a subject of current interest in hydrodynamic quantum analog experiments, as it may provide a means to trap walking droplets.

Pattern stabilization through parameter alternation in a nonlinear optical system

We report the first experimental realization of pattern formation in a spatially extended nonlinear system when the system is alternated between two states, neither of which exhibits patterning. Dynamical equations modeling the system are used for both numerical simulations and a weakly nonlinear analysis of the patterned states. The simulations show excellent agreement with the experiment. The nonlinear analysis provides an explanation of the patterning under alternation and accurately predicts both the observed dependence of the patterning on the frequency of alternation and the measured spatial frequencies of the patterns.

Stochastic resonance on two-dimensional arrays of bistable oscillators in a nonlinear optical system

We describe an experimental realization of stochastic resonance in two-dimensional arrays of coupled nonlinear oscillators. The experiment is implemented using an optoelectronic system composed of a liquid crystal light valve in a feedback loop with external, spatially variable noise being added through a liquid crystal display. The behavior of the system differs from previously studied uniform arrays, showing a high signal-to-noise ratio at the output for a broad range of input noise. We show that this behavior is qualitatively the same as that exhibited by computer models where the nonlinear elements of the array have a distribution of biases applied to their switching thresholds.

Spiritual well-being and personality

The hypothesis that High and Low Spiritual Well-being groups have different personality profiles was tested with 319 psychology undergraduates (132 men and 187 women who completed the Revised NEO Personality Inventory and the Spiritual Well-being Scale for partial course credit. Univariate analyses of variance indicated that the High Spiritual Well-being group scored lower on Neuroticism and higher or Extraversion, Agreeableness. and Conscientiousness than the Low Spiritual Well-being group. Multivariate analysis of variance indicated that the two groups had significantly different personality profiles, supporting the hypothesis.

Personality profiles of environmentally responsible groups

The hypothesis that groups high and low on environmental responsibility have different personality profiles was tested using responses of 319 introductory psychology students (132 men and 187 women) who completed the ECOSCALE and the Revised NEO Personality Inventory for partial course credit. Results of discriminant function analysis supported the hypothesis, indicating that groups scoring high and low on Environmental Responsibility had significantly different personality profiles and that the standard discriminant function coefficients were quite substantial (> or = .50) for Openness (.72) and Agreeableness (.50).

Stochastic resonance in two-dimensional arrays of coupled nonlinear oscillators

In this Brief Report we report the results of computer simulations on the periodic and noise driving of two-dimensional square arrays of coupled nonlinear oscillators. We find significant improvement in the output of these arrays over their one-dimensional counterparts (quantified by signal-to-noise ratio in the power spectrum at the frequency of the periodic driving). We also find that, within the limited resolution of our simulations, the one-dimensional scaling laws proposed by Lindner et al. [Phys. Rev. E 53, 2081 (1996)] seem to hold quite well for two-dimensional arrays.

Hardiness and major personality factors

This study tested Maddi and Khoshaba's 1994 hypothesis that Hardiness is an index of mental health. A sample of 241 undergraduates (103 men and 138 women) completed the Dispositional Resilience Scale, the Revised NEO Personality Inventory, and the Psychopathology-5 Scales. Using the individual median scores on the three subscales (Commitment, Control, and Challenge) of the Dispositional Resilience Scale, the High Hardiness group was obtained by identifying the individuals who scored above the medians on all the three subscales, whereas the Low Hardiness group were those who scored consistently below the medians on all the three subscales. Multivariate analysis of variance performed for the two hardiness groups using the scales from each personality inventory indicated that the two groups had significantly different mean profiles on the NEO Personality Inventory as well as the Psychopathology-5 Scales. Combined discriminant function analysis performed for the two hardiness groups using all the 10 scales from the two personality inventories indicated that the two groups had significantly different mean profiles and that the standard discriminant function coefficients were substantial (> .3) for the NEO Personality Inventory Openness (.65) and Conscientiousness (.49) scales and the Psychopathology-5 Positive Emotionality (.56) and Psychoticism (-.36) scales, supporting the tested hypothesis.

Type A behavior and the five-factor model of personality

The hypothesis that people classified as Type A and Type B have different personality profiles based on five major personality factors (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) was tested using the Student Jenkins Activity Survey and the Revised NEO Personality Inventory. Results based on discriminant function analysis of data from 243 psychology undergraduates (105 males and 138 females) strongly supported the hypothesis indicating that Type A and Type B groups have significantly different Revised NEO Personality Inventory profiles and that the standardized discriminant function coefficients were large for Agreeableness and Conscientiousness and moderately large for Extraversion.

Fringe visibility improvement using an asynchronous image-subtracting optically addressed spatial light modulator

We demonstrate the application of an asynchronous image-subtraction optically addressed spatial light modulator to particle image velocimetry fringe processing. The device comprises an amorphous silicon p-i-n-i-p photosensor and a ferroelelectric liquid-crystal light-modulating layer. The images to be subtracted are encoded on two separate wavelengths. The operation of the device is described, and characterization shows a frame rate of 100 Hz, a resolution of 3 line pairs/mm, and a write-light sensitivity of ≈1 mW/cm(2) at a wavelength of 514 nm. The device is read by the use of light with a 633-nm wavelength whereas the subtraction light is at a wavelength of 670 nm. Using this device to subtract a nonuniform pedestal from the optically computed power spectral density function (the Young's fringe pattern), we find we can improve the signal-to-clutter ratio of peaks in the image-transmittance autocorrelation function of particle image velocimetry transparencies. The device also permits processing of very low-visibility fringe patterns, generated from doubly exposed images, in which one image has half the transmittance of the other. These could not be processed with a nonsubtracting, binary, liquid-crystal optically addressed spatial light modulator.

Optoelectronic hit/miss transform for screening cervical smear slides

An optoelectronic morphological processor for detecting regions of interest (abnormal cells) on a cervical smear slide using the hit/miss transform is presented. Computer simulation of the algorithm tested on 184 Papsmear images provided 95% detection and 5% false alarm. An optoelectronic implementation of the hit /miss transform is presented, along with preliminary experimental results.

Smart-pixel spatial light modulator for incorporation in an optoelectronic neural network

We present the design, fabrication, and testing of a novel liquid-crystal-on-silicon optically addressed spatial light modulator for use as a weight matrix in an ART-1 optoelectronic neural processor. Each pixel in the 50 x 83 element array occupies 75 microm x 75 microm and consists of a photodetector, a threshold circuit, a 1-bit (flip-flop) memory element, and a liquid-crystal modulating mirror. The array is designed to switch all the pixels initially to the ON state. Subsequently each pixel is independently switched to the OFF state if a superthreshold amount of light falls upon the pixel's photodetector. The device has a contrast ratio of 20:1, a switch-on time (10-90% rise time) of 500 micros, and a switch-off time of ~500 micros (depending on the externally set threshold). Measured device uniformities and interpixel coupling are also described.

The effect of urea and cutting treatments on the production of Pangola grass in south-eastern Queensland

Urea at rates of 100, 300, and 500 lb N an acre a year, cutting intervals of 4, 8, and 12 weeks, and cutting heights of 2 inches and G inches were applied factorially to a Pangola grass sward in south-eastern Queensland (lat. 275) over a period of two years. Nitrogen applications increased the yields of dry matter and nitrogen, the nitrogen content and nitrogen recovery ; the responses were marked, significant, and quadratic. Responses to cutting intervals were significant and linear, but cutting height had only a slight effect and this was restricted to yield of dry matter. Maximum yields of dry matter were 21,000 lb an acre a year, of nitrogen 200 lb an acre a year, and the mean yield of nitrogen was 45 per cent of that applied. Growth was markedly seasonal ; production of dry matter in tops varied from about 1 lb an acre a day in winter to over 100 lb an acre a day in summer. It is considered that the major physical limitations to growth in this region are water shortage in summer and low temperatures in winter. Little growth was made when the average screen minimum temperature was less than 52�F, or the average night temperature less than 58�F, the maximum having less influence.